Select the histological findings to determine the risk of progression to gastric adenocarcinoma.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Risk stratification of patients with H. pylori and chronic gastritis
To guide surveillance intervals for precancerous gastric lesions (Metaplasia, Atrophy)
Evaluating biopsies from the stomach following a standard Sydney protocol
To identify patients needing aggressive H. pylori eradication and follow-up
Clinical Target
The Correa Cascade describes the multi-step progression from normal mucosa to intestinal-type gastric adenocarcinoma. It is the theoretical foundation for "search and treat" strategies for gastric cancer prevention.
Section 2
Formula & Logic
The 5-Step Progression
01
Normal Mucosa: Healthy gastric lining.
02
Chronic Non-Atrophic Gastritis: Typically H. pylori-induced inflammation without loss of glands.
03
Atrophic Gastritis (AG): Loss of specialized gastric glandular tissue; often replaced by fibrosis.
04
Intestinal Metaplasia (IM): Replacement of gastric epithelium with intestinal-appearing cells (Complete vs Incomplete).
Persistent H. pylori infection (the primary driving mutagen)
High salt intake and low intake of antioxidants (Vitamin C/E)
Smoking and family history of gastric cancer
Certain bacterial strains (CagA+, VacA+)
Section 3
Pearls/Pitfalls
The "Point of No Return"
While H. pylori eradication reduces cancer risk at any stage, its impact is most significant *before* the development of intestinal metaplasia. Once IM is widespread, eradication reduces but does not eliminate the risk, necessitating surveillance.
OLGA vs. OLGIM Staging
Modern guidelines (MAPS II) use the OLGA (Operative Link on Gastritis Assessment) and OLGIM (Intestinal Metaplasia version) staging systems to quantify the Correa cascade findings. Stage III and IV patients require intensive 3-year surveillance.
Clinical Pearls
Incomplete Intestinal Metaplasia (IM) has a higher malignant potential than complete (Type I) IM
A "Sydney Protocol" (5 biopsies: 2 Antrum, 2 Body, 1 Incisura) is mandatory to correctly stage the Correa cascade
Autoimmune Gastritis typically skips the Antrum and targets the Body/Fundus (different topography than H. pylori)
Section 4
Next Steps
Surveillance (MAPS II Guidelines)
01
Atrophic Gastritis or IM (Localized): No formal surveillance if no other risk factors.
02
Extensive AG or IM (Antrum AND Body): MRI/Gastroscopy every 3 years.
03
Dysplasia (Low Grade): Repeat endoscopy with mapping within 12 months.
04
Dysplasia (High Grade): Immediate endoscopic resection (EMR/ESD) or staging for surgery.
Complementary Staging Tools
OLGA Staging System
OLGIM Staging System
Updated Sydney System (Biopsy Mapping)
Section 5
Evidence Appraisal
The Foundational Model
Human gastric carcinogenesis: a multistep and multifactorial process--First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention.
Correa P. • Cancer Research. 1992;52(24):6735-40. The definitive description of the gastric cascade.
Dr. Pelayo Correa, a Colombian-American pathologist, revolutionized our understanding of gastric cancer through long-term epidemiological studies in high-risk areas of Colombia. His model proved that gastric cancer was not a "random strike" but the result of decades of chronic inflammatory injury driven by environmental and infectious factors.
